Hyaluronidase – When the Filler Needs to be Dissolved Again

Frustrated with the Results of Your Dermal Filler Treatment?

Discover How Hyaluronidase Can Swiftly and Effectively Dissolve Previously Injected Filler.

Hyaluronidase at a Glance

Hyaluronidase (in Germany: Hylase) is an enzyme that can dissolve hyaluronic acid. This allows for the correction of improper treatments or overcorrections with hyaluronic acid fillers.

The number of required treatments varies depending on the extent of the initial injection and the individual response of the body. For minor corrections, typically one session is sufficient.

The treatment can be a bit uncomfortable as Hylase does not contain an anesthetic.

Possible risks include swelling, redness, or bruising at the injection site. In rare cases, allergic reactions may occur.

A Hylase treatment does not require any downtime. You can resume your regular activities immediately.

The costs vary depending on the extent of the treatment and the number of required sessions. In my clinic, the dissolution of 0.5ml of hyaluronic acid costs approx. €200 per session (indicative, actual cost according to GOÄ).

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What is Hyaluronidase?

Hyaluronidase = Hylase in Germany

Hyaluronidase is an enzyme that is sold in Germany under the trade name Hylase. The enzyme Hyaluronidase naturally occurs in the human body. It breaks down hyaluronic acid into its individual molecular fragments, thereby loosening the tissue. This process, which is part of normal tissue regeneration in the body, allows for faster absorption of injected substances in medicine. The primary application of Hylase was long-established in ophthalmic surgery, where it enhanced the effectiveness of local anesthesia.

Hyaluronidase in Emergencies and for Corrective Purposes

The ability to break down hyaluronic acid with Hyaluronidase later proved useful in addressing complications or undesired outcomes after the injection of hyaluronic acid fillers. This is one of the reasons why hyaluronic acid became the preferred choice for wrinkle treatment, as it is the only filler material with an antidote in the form of Hyaluronidase. For the sake of patient safety, no reputable clinic specializing in hyaluronic acid treatments would be without having a decent stock of Hyaluronidase.

Hylase as a Lifesaver in Arterial Occlusion

Although serious complications after treatments by competent medical professionals are fortunately rare, they can lead to the occlusion of an arterial vessel, which, if left untreated, results in tissue destruction (necrosis). The rapid and abundant administration of Hyaluronidase can make the crucial difference in such incidents. Moreover, Hyaluronidase can also neutralize any corrective procedure that yields unsatisfactory aesthetic results.

Hylase Carries Allergenic Potential

The commonly used Hyaluronidase product Hylase Dessau in Germany is derived from bovine testicles. Thus, it may contain trace amounts of bovine protein. Therefore, in rare cases, allergic reactions accompanied by shock symptoms can occur after Hylase treatment. Consequently, its use in aesthetic medicine is not arbitrary, but should be limited to serious emergencies and significant corrective situations. Moreover, clinics that administer Hylase should be equipped for emergencies and have staff with relevant experience.

When is Hyaluronidase Recommended?

Since the use of Hylase is not without risks, and hyaluronic acid fillers are naturally broken down after a few months, corrective treatment with Hylase is not always necessary. For minor or visually inconspicuous corrections, it is often recommended to simply wait for the filler to naturally dissipate.

Hylase Costs are High for Frivolous Corrections

Considering the costs of Hylase, patients are advised to follow such an approach. To completely dissolve 1ml of hyaluronic acid, at least 2 x 1ml of Hylase with 150 units each are needed. This amounts to almost €400. When adding these costs to those of a subsequent re-treatment with hyaluronic acid, the overall package quickly becomes expensive.

Hylase in Case of Complications

The use of Hylase in emergencies is obligatory and should be routine for any practice that performs hyaluronic acid injections. Such emergencies do not necessarily involve the occlusion of an arterial vessel, but can also include inflammatory swelling that cannot be effectively treated with other means (such as corticosteroids). Such swellings typically occur in sensitive facial areas such as the tear trough. The majority of cases corrected with Hylase in my Munich-based practice involved this zone.

And for Poor Outcomes of Lip Injections

Aesthetically disturbing corrections refer to noticeable swelling and asymmetrical treatment results, often caused by uneven binding of tissue fluid by the filler. They are frequently the result of incorrect injection techniques. Such corrections are generally rare and mostly affect the sensitive tear trough and lip regions. Lip corrections with Hylase are the main reason why patients from outside seek treatment in my practice, typically after being injected by an inexperienced person.

How Long Should One Wait Before Undergoing a New Filler treatment after Hyaluronidase?

Individuals who have their undesired outcome of hyaluronic acid injections corrected with Hylase may consider undergoing a filler treatment soon after to achieve the originally desired outcome on the second attempt. This raises the question of how long Hyaluronidase remains active in the tissue and could counteract a subsequent hyaluronic acid injection.

The practice provides different answers, ranging from 2 to 3 days to 2 or 3 weeks. However, in reality, significant amounts of Hylase are unlikely to circulate in the tissue already 1–2 days after the injection. This is due to the very short half-life of Hyaluronidase, which is in the range of minutes.

Treatment Process

Due to the allergenic potential of Hylase and the associated possible side effects, I prioritize comprehensive patient education in my practice before the treatment. During the consultation, I also try to determine if the use of Hylase is indeed necessary or if it would be more appropriate to wait for the natural degradation of the filler. To check for any allergic reactions, I also perform a patch test on the patient’s forearm.

Cleansing, Anesthesia, and Injection

After thorough cleansing and disinfection of the treatment area, I apply a numbing cream, which requires approximately 30 minutes to take effect. Following that, Hyaluronidase is injected using a thin needle. Since Hylase does not contain lidocaine like commonly used hyaluronic acid fillers, the injection may cause a slight burning sensation despite the numbing.

Immediate onset of action

The effect of Hyaluronidase is immediate. Typically, within 12 to 24 hours, the unwanted hyaluronic acid is completely dissolved. The treatment itself does not exceed 45 minutes. In most cases, a single session is sufficient to fully address any corrective measures.

Possible Risks and Side Effects of Hylase

Hylase is generally well tolerated, even at high doses. However, due to the possible low content of bovine proteins, allergic reactions cannot be completely ruled out. It is important to inform your doctor before the treatment if you have a known hypersensitivity to bovine protein. Your doctor should also be equipped with appropriate emergency equipment to handle a severe allergic reaction.

Undesirable Aesthetic Effect with Overdosing

The effect of Hylase treatment affects both previously injected hyaluronic acid and endogenous hyaluronic acid. The enzyme does not distinguish between them. Overdosing of Hyaluronidase can result in the breakdown of endogenous hyaluronic acid, leading to aesthetically unfavorable volume loss. Although this effect is temporary as endogenous hyaluronic acid quickly regenerates, it can still appear visually unfavorable and cause psychological distress for a few weeks. To prevent overdosing of Hylase, the treatment should always be performed by experienced physicians.

Caution with Corrections, High Dosage in Emergencies

In my clinic in Munich, I therefore take a cautious approach to dosing Hylase for purely aesthetic corrections. As mentioned above, for complete dissolution, I start with approximately 300 units of Hylase per 1ml of hyaluronic acid to be dissolved. However, in true emergencies, especially in cases of vascular complications, I would administer Hylase in a large area and at very high doses of 3000 units or more.

When is Hylase Contraindicated?

Hylase must not be used:

In cases of known hypersensitivity or allergy to Hyaluronidase or any of its components.

In patients with a history of severe allergic reactions to Hyaluronidase or similar enzymes.

In patients with an active infection or inflammation in the treatment area.

In patients with bleeding disorders or taking anticoagulant medications, as it may increase the risk of bleeding.

In patients with compromised immune systems or immunodeficiency disorders.

In patients with open wounds or skin lesions in the treatment area.

In pregnant or breastfeeding women, as the safety of its use during these times has not been sufficiently studied.

In patients with active autoimmune disease or systemic lupus erythematosus.

What Does Hyaluronidase Cost?

The cost of a Hyaluronidase (Hylase) treatment depends on the type of intervention and the amount of Hylase used. This in turn depends on the volume of hyaluronic acid filler to be dissolved.

In my practice in Munich, Hyaluronidase treatment costs typically range between €200 and €400, with the volumes of hyaluronic acid to be dissolved falling within the range of 0.5ml to 1ml at these prices. Please note that the mentioned prices are indicative and for orientation only. Individual treatments are billed according to the German Medical Fee Schedule (GOÄ), and therefore may deviate from these indications, even significantly.

Portrait von Dr. Eva Maria Strobl von Lips and Skin München

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About the author:

Dr. med. univ. Eva Maria Strobl is the owner of LIPS and SKIN Aesthetic Medicine practice in Munich. She is a trained specialist in general medicine (MedUni Vienna) and has over 10 years of specialization in non-surgical aesthetic procedures. Dr. Strobl is a member of the German Society for Aesthetic Botulinum Therapy e.V. (DGBT), the German Society of Anti-Aging Medicine e.V. (GSAAM) and of Network Global Health. She publishes regularly on her blog and on DocCheck.

Sources of this article:

De Maio, MD Codes™: A Methodological Approach to Facial Aesthetic Treatment with Injectable Hyaluronic Acid Fillers, Link.
Seo, Facial Volumization with Fillers, Springer

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